Healthcare Provider Details

I. General information

NPI: 1275700882
Provider Name (Legal Business Name): MONTEREY COUNTY BEHAVIORAL HEALTH DIVISION DBA CENTRAL COAST DTX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2995 RENDOVA RD
MARINA CA
93933-4451
US

IV. Provider business mailing address

2995 RENDOVA RD
MARINA CA
93933-4451
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4510
  • Fax: 831-424-9809
Mailing address:
  • Phone: 831-755-4510
  • Fax: 831-424-9809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ZEKE VEGA
Title or Position: CFO
Credential:
Phone: 831-755-4510